The early management of the burned patient in the Naval service

Abstract

Burns represent a perpetual threat in military combat and are a pervasive threat in the land, maritime and air arenas. Therefore, it is imperative that military clinicians are well versed in managing burns in order to ensure optimal survival and recovery. This article aims to explore the epidemiology, pathophysiology, assessment and early management of the burned patient with a focus on the austere maritime environment and current military guidance.

Injury Trends aboard U.S. Navy Vessels: A 50-year analysis of Mishaps at Sea

“…The most recent examples of large-scale modern naval warfare during a peer/near-peer conflict occurred during the 10-week-long Falklands War in 1982 between Argentina and the United Kingdom. Of the 516 battle casualties (land and sea), 52.3% suffered penetrating wounds, 21% burns, 15.5% asphyxiation/inhalation, and 13.4% immersion/hypothermia injuries 17,41,42 …”

“…However, a recent policy was initiated to mandate 5 units of low-titer whole blood available during deployments. Including aircraft carriers and amphibious warships (with stored blood products), only 17.4% 42 of all active USS vessels are WBB capable. None of the IDC-led medical departments including destroyers, cruisers, and submarines are WBB capable; whole blood resuscitation in hemorrhagic shock is foundational to both TCCC and PCC.…”

“…Of the 516 battle casualties (land and sea), 52.3% suffered penetrating wounds, 21% burns, 15.5% asphyxiation/ inhalation, and 13.4% immersion/hypothermia injuries. 17,41,42 During routine or contingency operations, deployed shipboard providers must be clinical experts in providing trauma, burn, and critical care including initial resuscitation and ongoing stabilization in the maritime environment for prolonged periods. In a review of naval mass casualty incidents, those injured were transferred off the damaged ships within minutes to up to nearly 8 hours after injury.…”

The Effect of Blast-Related Burn Injuries from Prolonged Field Care to Rehabilitation and Resilience: A Review of the Scientific Literature

“…One study of a major mass casualty event, for example, found that initial TBSA diagnosis was a statistically significant predictor of infection (Kao et al, 2018). Earlier research has found that morbidity and mortality are significantly increased in burn injuries with TBSA greater than 40 percent and that the inflammation process affects the whole body in injuries with TBSA greater than 20 percent (Rylah and Smith, 2015).…”

“…The clinical assessment method considered to be most accurate is the Lund-Browder chart, which was developed in the 1940s and divides the body into several age-adjusted regions; the clinician assesses the extent of burn within each (Lund and Browder, 1944;Martin, Lundy, and Rickard, 2014). Alternatives, including the "rule of nines" and serial halving, have been developed for use in settings in which the Lund-Browder method is infeasible, including forward-deployed environments (Rylah and Smith, 2015). These methods involve roughly parti-tioning the body into regions to bound the extent of the burn and are considered to be sufficiently accurate for early assessment and triage, but not for treatment at Role 3 facilities or full medical treatment facilities (Martin, Lundy, and Rickard, 2014).…”